Urinary incontinence has been documented to be a common and costly problem among more than fifty percent of nursing home (NH) residents. Unfortunately soiled pads are often changed, by nursing staff, without cleansing the skin. The task of changing diapers or pads, cleansing, and protecting skin are separate Steps and use different products, which are currently packaged separately. This study proposes to develop an efficient system that combines the above products within one step. The new One Step system will leave no excuse for failure to clean the perineal area while changing soiled pads or diapers. The objectives are: 1) to generate data assessing the current incontinence care practices of nurse aides, 2) to develop a prototype of the One Step system that incorporates a cleansing and protecting wipe with the incontinence pad in a way that encourages proper perineal care, and 3) to demonstrate that the One Step system is practical and leads to an increase in the frequency of skin cleansing activities without a commensurate increase in the time that aides spend in incontinence care. If we demonstrate that it is practical in Phase I, the One Step system will be tested in multiple NHs during Phase II research. Skin health and satisfaction of both residents and caregivers will be major outcome measures and we will also consult with industrial engineers to develop cost effective manufacturing technology for the One Step system. The One Step system not only has profound health and cost benefits but it also has far-reaching commercial applications in the nursing home, hospital, daycare, and home setting. Thus in order to make the One Step system available, we will be contracting with manufacturers and distributors.